The goals of this phase III clinical trial is to determine effectiveness in the setting where it will be implemented as well as to gain an understanding of the context for implementation. Effectiveness of CaRE-4-alloBMT will be assessed using a parallel two-arm pragmatic randomized controlled trial (pRCT). Pragmatic trials are undertaken in "real world" settings and place a greater emphasis on external validity and generalizability to support the decision on whether to deliver an intervention. Participants will: * Complete a questionnaire package and an initial assessment with a registered Kinesilogist * Randomized into either the CaRE-4-alloBMT (Intervention group) or the Usual Care group. * Complete the patient reported outcome measures and physiological assessments at baseline (T0), hospital admission (T1), hospital discharge (T2), 3-months post-discharge (T3), and 6 months post-discharge (T4). Usual Care (UC). The UC group will receive standard cancer care provided to all patients undergoing alloBMT at Princeess Margaret, including the provision of self-directed online resources and a booklet-based physiotherapy program outlining the role of exercise and examples of exercises that can be done at the hospital and at home during recovery. At admission, patients undergo a nutrition assessment by the alloBMT dietician and are provided a caloric intake goal. They are asked to track their food intake through a food journal that is monitored by the alloBMT dietitian. When needed, as determined by the alloBMT team, patients are given access to supportive care services including psychosocial oncology and in-patient and outpatient rehabilitation. CaRE-4-alloBMT (Intervention, INT): Patients randomized to the intervention arm will receive usual care plus the CaRE-4-alloBMT intervention. The CaRE-4-alloBMT program is delivered from 4-8 weeks pre-transplant through to 6 months post-transplant (estimated at 8-9 months total). It uses a person-centered strategy and a multidimensional approach targeting physical activity and promoting self-management skills to enhance nutrition, psychosocial functioning and to help manage common side effects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
208
The program is informed by established behaviour change theory, including motivational interviewing (MI), theory of planned behaviour, self-efficacy, and the model of supportive accountability, and has a number of embedded behaviour change techniques, which are known to increase effectiveness. The program also harnesses current and emerging eHealth technologies to overcome barriers to accessing and providing cancer rehabilitation. Key components of the intervention are: 1) Individualized progressive exercise prescriptions; 2) Remote monitoring of heart rate, sleep and weight with Fitbit devices; 3) Self-management skills teaching (online modules on topics such as exercise, eat and cook for wellness, mindfulness, fatigue, brain health, etc); 4) Person-to-person clinical support (remote check-in calls with a kinesiologist)
Princess Margaret Cancer Centre
Toronto, Ontario, Canada
RECRUITING36-Item Short Form Health Survey questionnaire (SF-36)
The SF-36 is a measure of health status and consists of 36 questions that cover eight health domains and two summary scales: the physical component summary (PSC) and the mental component (MSC). For this project the PCS was chosen as the primary outcome. The minimum score value is a zero and represents the lowest level of health, maximum disability or severe pain. The maximum score is 100 and represents the highest value of health, no disability or no pain.
Time frame: 3 months post-discharge
Initial hospital stay Transplant outcomes
Initial length of stay will be measured in days and will extracted from patient charts at the end of the study.
Time frame: Year 4
Number of readmission Transplant outcomes
The number of readmissions per patient who underwent alloBMT and participating in the study will extracted from patient charts at the end of the study.
Time frame: Year 4
Number of days in hospital Transplant outcomes
The total number of days spent in the hospital by patients who underwent alloBMT and participating in the study will extracted from patient charts at the end of the study.
Time frame: Year 4
Overall survival Transplant outcomes
Overall survival (transplant-related mortality vs survival rates) patients who underwent alloBMT and participating in the study will extracted from patient charts at the end of the study.
Time frame: At year 4
EQ 5D 5L
The instrument is a standardized descriptive system comprising five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each evaluated through a single item and measures quality of life. The maximum score of 1 represents having no problems in any of the 5 dimensions and best health while a minimum score of a negative value indicates worse health.
Time frame: 9 months
Modified Patient-Generated Subjective Global Assessment
The instrument is a one-page tool that classifies patients into four nutritional levels, which are predictive of overall survival in cancer patients and measures nutritional status.
Time frame: 9 months
Hospital Anxiety and Depression Scale (HADS)
This instrument includes 2 subscales designed to identify and quantify depression and anxiety in physically ill patients. The minimum score of zero and a maximum score of 21 where a higher score indicates higher distress.
Time frame: 9 months
12-item World Health Organization's Disability Assessment Schedule 2.0 (WHODAS 2.0)
The instrument measures disability in accordance with the International Classification of Functioning, Disability, and Health. Participants rate their ability to perform 12 activities across six domains of functioning. A minimum score of zero indicates no disability and a maximum score of 48 indicates full disability.
Time frame: 9 months
Demographic and clinical information
Demographic and clinical details will be collected from participants at the time of initial assessment via an intake questionnaire, including age, sex, gender, ethnicity, education level, socioeconomic status, and comorbidities.
Time frame: A one-time questionnaire to be completed at baseline/prior to initial assessment.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.